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General NPI Number Information
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NPI Number | 1184258832
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Entity Type | Organization
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Legal Business Name | SQUARE 1 CLINICS, INC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 1212 COURT ST
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City | CLEARWATER
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State | FL
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Zip | 33756-5004
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Country | US
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Telephone | 727-351-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 COURT ST
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City | CLEARWATER
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State | FL
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Zip | 33756-5004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MR. LAMBERT WAYNE LEROUX
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Credential |
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Telephone | 727-480-4981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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